Publication 971 (Rev. April 2008) - Innocent Spouse Relief Page 12
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238857
Request for Innocent Spouse Relief
Form
OMB No. 1545-1596
(Rev. June 2007)
Department of the Treasury
Do not file with your tax return.
See separate instructions.
(99)
Internal Revenue Service
Important things you should know
● Answer all the questions on this form that apply, attach any necessary documentation, and sign on page 4. Do not delay
filing this form because of missing documentation. See instructions.
● By law, the IRS must contact the person who was your spouse for the years you want relief. There are no exceptions,
even for victims of spousal abuse or domestic violence. Your personal information (such as your current name, address,
and employer) will be protected. However, if you petition the Tax Court, your personal information may be released. See
instructions for details.
● If you need help, see How To Get Help in the instructions.
Part I
Should you file this form? You must complete this part for each tax year.
Tax Year 1
Tax Year 2 Tax Year 3*
1
Enter each tax year you want relief. It is important to enter the correct year. For example,
if the IRS used your 2006 income tax refund to pay a 2004 tax amount you jointly owed,
2004
1
enter tax year 2004, not tax year 2006
Caution. The IRS generally cannot collect the amount you owe until your request for each
year is resolved. However, the time the IRS has to collect is extended. See Collection
Statute of Limitations on page 3 of the instructions.
2
Check the box for each year you would like a refund if you qualify for relief. You may
2
be required to provide proof of payment. See instructions
Yes
No
Yes
No
Yes
No
3
Did the IRS use your share of the joint refund to pay any of the following past-due
debts of your spouse: federal tax, state income tax, child support, spousal support,
or federal non-tax debt such as a student loan?
● If “Yes,” stop here; do not file this form for that tax year. Instead, file Form 8379. See
instructions.
● If “No,” go to line 4
3
4
Did you file a joint return for the tax year listed on line 1?
● If “Yes,” skip line 5 and go to line 6.
● If “No,” go to line 5
4
5
If you did not file a joint return for that tax year, were you a resident of Arizona,
California, Idaho, Louisiana, Nevada, New Mexico, Texas, Washington, or Wisconsin?
● If “Yes,” see Community Property Laws on page 2 of the instructions.
● If “No” on both lines 4 and 5, stop here. Do not file this form for that tax year
5
*If you want relief for more than 3 years, fill out
an additional form.
Part II
Tell us about yourself
6
Your current name (see instructions)
Your social security number
Janie Boulder
123
00
9876
Your current home address (number and street). If a P.O. box, see instructions.
Apt. no.
County
5161 Old Farm Estates
Montgomery
City, town or post office, state, and ZIP code. If a foreign address, see instructions.
Best daytime phone number
Hutchinson, IA 55555
721
555-1023
(
)
Part III
Tell us about you and your spouse for the tax years you want relief
7
Who was your spouse for the tax years you want relief? File a separate Form 8857 for tax years involving different spouses or
former spouses.
That person’s current name
Social security number (if known)
Joe E. Boulder
234
00
8765
Current home address (number and street) (if known). If a P.O. box, see instructions.
Apt. no.
3895 Timber Way
City, town or post office, state, and ZIP code. If a foreign address, see instructions.
Best daytime phone number
Creekbed, WY 77777
271
555-2345
(
)
8857
For Privacy Act and Paperwork Reduction Act Notice, see instructions.
Cat. No. 24647V
Form
(Rev. 6-2007)
Page 12
Publication 971 (April 2008)
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